Inflammatory bowel disease (IBD) is a term encompassing several conditions involving chronic inflammation in the gastrointestinal tract. Two of the most debilitating forms of IBD are ulcerative colitis (UC) and Crohn's disease (CD). These diseases affect young people, with a typical debut at the age of 20-30 years, and disease management is a long-term commitment for both patient and physician, since there is currently no cure for either condition. Approximately 30% of IBD patients undergo surgery during their lifetime and patients with long-standing IBD are at considerable risk of developing colorectal cancer. Three out of ten IBD patients do not respond to the best available medical therapy today, even when high doses are used, causing considerable side effects.
Treatment of patients with active UC aims at reducing inflammation and promoting colon healing and mucosal recovery. The underlying cause of UC is not understood, nor is it known what triggers the disease to recur between its inactive and active forms. However, the active stage of the disease is characterised by significant inflammation of the mucosa, increased cell permeability, loss of protein and fluids. In severe stages deep inflammation of the bowel wall may develop with abdominal tenderness, tachycardia, fever and risk of bowel perforation.
One early symptom of ulcerative colitis is constipation with passage of blood or mucus in the stools. Several months or years may pass before diarrhoea develops with abdominal pain. Later symptoms include severe fatigue, weight loss, loss of appetite, fever and occasionally arthralgia.
The road to an established diagnosis of ulcerative colitis often includes a thorough study of the patient's medical history, the exclusion of other conditions, as well as several tests, e.g. blood tests, stool examination, barium enema X-ray, sigmoidoscopy, colonoscopy, and biopsy. The biopsy may be performed as part of a sigmoidoscopy or colonoscopy examination.
It is obvious that a possibility to clinically distinguish UC from colonic CD at an early stage would provide enormous benefits for both the patient and the physician. It would permit the design of accurate treatment regimes, prevent unnecessary medications and reduce treatment costs. Even though the overall clinical picture in IBD patients may show some clinically important differences between the major patient groups of UC and CD, there are substantial similarities, thus making it difficult for health care personnel to establish a correct diagnosis.